POS1462 CAUSES OF DEATH IN PATIENTS WITH RHEUMATIC AND AUTOIMMUNE DISEASES: A 15-YEAR-OLD AUTOPSY-BASED STUDY.
Authors: M. J. Mantilla Ribero, J. C. Santacruz Devia, J. Londono, A. M. Santos, G. J. Rodriguez, I. Rueda, J. C. Mantilla
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with rheumatic and autoimmune diseases have susceptibility to fatal outcomes and may seem less deadly than they actually are. Objectives To describe the main causes of death as determined by autopsy findings, in patients with rheumatic and autoimmune diseases in a central hospital of the Colombian north-east. Stress the importance of autopsy as a teaching, research tool and education in medicine. Methods A retrospective, descriptive study of the database from the Pathology Department at UIS in Bucaramanga, Colombia. A total of 4,430 autopsies were performed between January 2004 and December 2019 in patients whose death occurred at Hospital Universitario de Santander or other hospitals in the Bucaramanga metropolitan area. Perinatal autopsy cases were excluded (2,181) and 2,249 autopsy protocols were analyzed, of which 47 corresponded to patients with a rheumatic and autoimmune disease (Figure 1). Figure 1. Flowchart of case selection Results A total of 47 cases were included, 27 (57.5%) were female and 20 (42.5%) were male. The mean age was 39 years old with a range from 13 to 69 years old. The most common disease was systemic lupus erythematosus (40.5%) and rheumatoid arthritis (29.8%), followed by autoimmune hepatitis and gouty arthritis with 3 cases (6.4%) each one. The most common cause of death determined by the autopsy findings was infections (66%) of which more than half were due to opportunistic pathogens, with tuberculosis being the predominant cause with 12 cases. The second cause was organic compromise due to disease activity (23.4%), and lastly other causes (10.6%) such as pulmonary embolism or myocardial infarction, which conditions more likely to present in patients with a rheumatic and autoimmune disease. A detailed description of the case series is displayed in Table 1. Almost all patients were receiving immunosuppressive therapy. The most used agents were prednisone (85%), methotrexate (19%), and azathioprine (15%). The other immunosuppressive medications were cyclophosphamide and tumor necrosis factor inhibitors in 2 cases each one. Table 1. Causes of death determined at autopsies findings. Disease n (%) Cause of death SLE 19 (40,5) RA 14 (29,8) AH 3 (6,4) GA 3 (6,4) SSc 2 (4,2) DMPM 2 (4,2) GS 2 (4,2) Others* 2 (4,2) Pneumonia (CAP) 5 (26,2) 3 (21,4) 1 (33,3) - 1 (50) - - - Septic shock 2 (10,5) 2 (14,3) - - - - - - Opportunistic Infection 5 (26,2) 6 (42,9) - 2 (66,6) 1 (50) 2 (100) - 1 (50) Renal failure 3 (16) - - - - - 2 (100) - Respiratory failure - - - - - - - - Hepatic failure - - 2 (66,6) - - - - 1 (50) MODS 3 (16) - - - - - - - Pulmonary embolism 1 (5,1) 1 (7) - - - - - - Myocardial infarction - 2 (14,3) - 1 (33,3) - - - - *Others: Primary biliary cholangitis 1 case and Pemphigus vulgaris 1 case. SLE= Systemic lupus erythematosus; RA= Rheumatoid arthritis; AH= Autoimmune Hepatitis; GA= Gouty Arthritis; SSc= Systemic sclerosis; DMPM= Dermatopolymyositis; GS= Goodpasture Syndrome; CAP= Community-acquired Pneumonia; OI= opportunistic infections; MODS= Multiple organ dysfunction syndrome. Conclusion The causes of death in our autopsy series match previous studies in these population. The leading cause of death were infections and most cases occurred in young and middle-aged women. These results support previous reports regarding the importance of infections as a cause of death in patients with rheumatic and autoimmune diseases and the fatal outcomes of a severe activity of the uncontrolled disease. It is a challenge for the clinician to treat patients with these conditions and to achieve a balance between obtaining an effective treatment (usually high doses of immunosuppressive drugs) and minimizing the risks of adverse events related to the medications, such as infections. References: [1]Mitratza M, et al. Systemic autoimmune disease as a cause of death: mortality burden and comorbidities. Rheumatology (Oxford). 2021;60(3):1321–30. [2]Garen T, et al. Mortality and causes of death across the systemic connective tissue diseases. Rheumatol UK. 2019;58(2):313–20. Disclosure of Interests None declared